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Abstract
Objectives: Drop-foot when incurred as a deficit post-stroke significantly contributes to the development of physical disability and social restriction. The condition is most commonly treated using a custom moulded ankle foot orthosis (AFO) or functional electrical stimulation (FES). No previous systematic review has assessed the evidence for both an orthotic (while the device is still on) and therapeutic (when the device is no longer worn) effect of FES, including all types of methodology and outcome measure. This is certainly a gap in the literature in terms of informing the practising clinician.
Methods: A systematic search was conducted to identify all articles published between 1990 and 2008 relating to the effectiveness of FES for the treatment of drop-foot post-stroke using strict inclusion/exclusion criteria. Included literature was quality-appraised according to the Guidelines for Cochrane reviewers.
Results: Thirty studies were analysed (264 excluded) and results support the conclusion that FES can have a positive orthotic effect particularly for gait speed and physiological cost index (PCI), in chronic post-stroke patients. Research supporting a therapeutic effect of FES post-stroke is less conclusive. Some support exists for FES in combination with 'conventional rehabilitation' or treadmill training or for increasing the effectiveness of Botulinum toxin injections.
Discussion: While more evidence exists to support an orthotic than therapeutic effect of FES, further research is needed to define the extent of a therapeutic effect (particularly in acute patients) and compare the efficacy of FES with an AFO. More standardisation of protocols and a more collaborative approach between engineers, researchers, clinicians and users is required.